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Excluded Employee Leave Buy Back form

Excluded Employee Leave Buy Back form

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Published by jon_ortiz
California Department of Social Services leave cash out form for excluded employees
California Department of Social Services leave cash out form for excluded employees

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Published by: jon_ortiz on Apr 14, 2014
Copyright:Traditional Copyright: All rights reserved

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04/14/2014

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TO: VERONICA LORTA, Manager Payroll and Support Services Bureau FROM:
Employee’s Name
 _____________________________________________ Division/Branch/Unit _____________________________________________
SUBJECT: EXCLUDED EMPLOYEE LEAVE BUY-BACK PROGRAM FOR FISCAL YEAR 2013-14
I hereby elect to participate/not to participate in the Excluded Employee Leave Buy-Back Program for Fiscal Year 2013-14 as described below. I elect not to participate in the Excluded Employee Leave Buy-Back Program for Fiscal Year 2013-14. I elect to participate in the Excluded Employee Leave Buy-Back Program for Fiscal Year 2013-14 and certify that I have available leave balances in order to participate in this buy-back program. I elect to buy-back/cash out the below hours of leave. Vacation Hours: ________ Annual Leave Hours: _______ Personal Leave Hours: PL 1992: _______ PL 2003: _______ PLP 2010/11/12: _______ Voluntary Personal Leave (VPLP) Hours: ______ Personal Holiday: ____ (converted to hours) Holiday Credit Hours: _____ Total leave hours elected to buy-back (not to exceed 20 hours): _______

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